Endoscopic treatment instrument

ABSTRACT

An endoscopic treatment instrument is provided which includes: a flexible sheath; a wire disposed inside the sheath so as to advance and retreat; a restriction member which restricts a movement of the wire in the sheath to a proximal side; an operating portion connected to a proximal end of the sheath; a wire operating portion which is connected to a proximal end of the wire and disposed to advance and retreat relative to the operating portion; a resilient member which has a first end and a second end and of which the first end is connected to the wire operating portion to expand and contract between the second end; a movable member which is connected to the second end so as to be movable relative to the operating portion; and a control member which is disposed in the movable member and which switches the movable member between a movable state and a fixed state relative to the operating portion.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an endoscopic treatment instrumentusing an endoscope.

2. Description of the Related Art

When a treatment is performed inside a human body, it can be classifiedinto surgical incision of the patient's body and oral or anal endoscopictreatment. The oral endoscopic treatment can be used to suture aperforation of a digestive canal. At this time, a suture tool having asuture thread extending from an anchor is inserted to a perforation inan oral endoscopic manner, punctures a tissue in the vicinity of theperforation with the suture tool housed in a puncture needle, and pushesup the anchor connected to the suture thread out of the puncture needle.By pulling out the puncture needle from the tissue and then tying twosuture threads with the perforation interposed therebetween, theperforation is sutured (see U.S. patent application Ser. No.11/238,016).

SUMMARY OF THE INVENTION

An aspect of the invention includes: a flexible sheath; a wire disposedinside the sheath so as to advance and retreat; a restriction memberwhich restricts movement of the wire in the sheath to a proximal side;an operating portion connected to a proximal end of the sheath; a wireoperating portion which is connected to a proximal end of the wire anddisposed to advance and retreat relative to the operating portion; aresilient member which has a first end and a second end and of which thefirst end is connected to the wire operating portion to expand andcontract between the second end; a movable member which is connected tothe second end so as to be movable relative to the operating portion;and a control member which is disposed in the movable member and whichswitches the movable member between a movable state and a fixed staterelative to the operating portion.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram illustrating the entire general appearance of asuture instrument according to a first embodiment of the invention.

FIG. 2 is a diagram illustrating the entire general appearance of asuture tool used in the suture instrument according to the firstembodiment of the invention.

FIG. 3 is a perspective view illustrating a stopper of the suture tool.

FIG. 4 is a side view of the stopper shown in FIG. 3.

FIG. 5 is a development view illustrating the stopper shown in FIG. 3.

FIG. 6 is a partially enlarged view illustrating a modified example ofthe stopper shown in FIG. 3.

FIG. 7 is a partially enlarged sectional view of the suture instrument.

FIG. 8 is a partial perspective view of the suture instrument.

FIG. 9 is a cross-sectional view taken along line D-D of FIG. 8.

FIG. 10 is a cross-sectional view taken along line A-A of FIG. 1.

FIG. 11 is a cross-sectional view taken along line B-B of FIG. 1.

FIG. 12 is a diagram illustrating the entire general appearance of anendoscope used along with the suture instrument.

FIG. 13 is an explanatory diagram illustrating a state where a suturethread is inserted into the stopper shown in FIG. 3.

FIG. 14 is an explanatory diagram illustrating a state where a suturethread is inserted into the stopper shown in FIG. 3.

FIG. 15 is an explanatory diagram illustrating a state where a suturethread is inserted into the stopper shown in FIG. 3.

FIG. 16 is an explanatory diagram illustrating a state where a suturethread is inserted into the stopper shown in FIG. 3.

FIG. 17 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 18 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 19 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 20 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 21 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 22 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 23 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 24 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 25 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 26 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 27 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 28 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 29 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 30 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 31 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 32 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 33 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 34 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 35 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 36 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 37 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 38 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 39 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 40 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 41 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 42 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 43 is an explanatory diagram illustrating an operation of thesuture instrument.

FIG. 44 is a perspective view illustrating a modified example of asuture needle of the suture instrument.

FIG. 45 is a partially sectional view illustrating a modified example ofthe suture needle of the suture instrument.

FIG. 46 is a cross-sectional view taken along line I-I of FIG. 45.

FIG. 47 is a cross-sectional view taken along line II-II of FIG. 45.

FIG. 48 is a partially enlarged perspective view illustrating a modifiedexample of the suture instrument.

FIG. 49 is an explanatory diagram illustrating an operation of thesuture instrument shown in FIG. 48.

FIG. 50 is a partially enlarged perspective view illustrating a modifiedexample of the suture instrument.

FIG. 51 is a partially enlarged perspective view illustrating a modifiedexample of the suture instrument.

FIG. 52 is a partially enlarged sectional view illustrating a modifiedexample of the suture instrument.

FIG. 53 is a perspective view illustrating an over view of modifiedexample of the suture instrument.

FIG. 54 is a perspective view illustrating an over view of modifiedexample of the suture instrument.

FIG. 55 is a perspective view illustrating an over view of modifiedexample of the suture instrument.

FIG. 56 is a perspective view illustrating an over view of modifiedexample of the suture instrument.

FIG. 57 is a perspective view illustrating an over view of modifiedexample of the suture instrument.

FIG. 58 is a diagram illustrating the entire general appearance of aBiopsy forceps according to a second embodiment of the invention.

FIG. 59 is a side view illustrating the Biopsy forceps shown in FIG. 58.

FIG. 60 is an explanatory diagram illustrating an operation of theBiopsy forceps.

FIG. 61 is an explanatory diagram illustrating an operation of theBiopsy forceps.

FIG. 62 is an explanatory diagram illustrating an operation of theBiopsy forceps.

FIG. 63 is an explanatory diagram illustrating an operation of theBiopsy forceps.

BEST MODE FOR CARRYING OUT THE INVENTION

Best mode for carrying out the invention will be described in detailbelow. In the following description, like elements are denoted by likereference numerals and repeated description is omitted.

First Embodiment

As shown in FIGS. 1 and 2, a suture instrument (endoscopic treatmentinstrument) 1 according to a first embodiment of the present inventionincludes a suture tool 6 having an anchor 2 anchored to a biologicaltissue which is not shown, a suture thread 3 drawn out of the anchor 2,and a stopper 5 disposed on the suture thread 3; a sheath 9 having ahollow puncture needle 7, which can house the anchor 2 thereinside,having a hard needle portion 7A formed with an opening 7 a at the distalend thereof and an outer sheath 8 which houses the puncture needle 7 soas to advance and retreat; an operating portion 14 having a pusher(wire) 10 which is disposed to advance and retreat in the punctureneedle 7 and a proximal side of which extends to a proximal side withits distal end 10 a being in contact with the anchor 2, an operatingportion body 11 which is connected to and extends from a proximal end ofthe outer sheath 8, and a needle slider (a first operating portion) 12which is firmly fixed to a proximal end of the puncture needle 7 anddisposed to the operating portion body 11 so as to advance and retreat;a pusher operating portion (a wire operating portion, a second operatingportion) 13 which is connected to a proximal end of the pusher 10 anddisposed to the operating portion body 11 so as to advance and retreat;a spring member (a resilient member) 15 which has a first end 15 a and asecond end 15 b and the first end 15 a is connected to the pusheroperating portion 13 and which expands and contracts between the secondend 15 b; a movable stopper (movable member) 16 which is connected tothe second end 15 b and which is movable relative to the operatingportion 12; and a lock member (a control member) 17 which is disposed inthe movable stopper 16 and which switches the movable stopper 16 betweena movable state and a fixed state relative to the operating section 12.

The anchor 2 of the suture tool 6 includes a first anchor 2A and asecond anchor 2B. The anchors 2A and 2B have the same elongatedcylindrical shape and have a groove 2 a in the circumferential directionat the center portion thereof. A first end 3 a of the suture thread 3 isconnected to and extended from the vicinity of the groove 2 a of thefirst anchor 2A and is bent back to form a loop 18 in which the pusher10 is able to be inserted, and a second end 3 b is connected to thevicinity of the groove 2 a of the second anchor 2B.

As shown in FIGS. 3 to 6, the stopper 5 has a base portion 5A and a pairof bent pieces 5B and 5C which are formed by bending back both end sidesof a band-shaped thin plate member toward the center side. The baseportion 5A of the stopper 5 is provided with a through-hole 5 a throughwhich the suture thread 3 can be inserted. The pair of bent pieces 5Band 5C is disposed to be substantially parallel to the base portion 5A.

The distal ends of the pair of bent pieces 5B and 5C are provided withthick plate portions 5 b and 5 c, which are thick in the insertiondirection of the suture thread 3 and sandwich the suture thread 3therebetween, at positions decentered in a direction separating eachother from the center axis C of the pair of bent pieces 5B and 5C. Thedistance L between the thick plate portions 5 b and 5 c is smaller thanthe diameter of the suture thread 3.

An engaging protrusion portion 5 d protruding toward a gap S1 formedbetween a side periphery of the bent piece 5B and the thick plateportion 5 b due to the decenterization is formed in the thick plateportion 5 c disposed in the other bent piece 5C which is opposing thebent piece 5B. Similarly, an engaging protrusion portion 5 e protrudingtoward a gap S2 formed between a side periphery of the bent piece 5C andthe thick plate portion 5 c is formed in the thick plate portion 5 bdisposed in the bent piece 5B.

The stopper 5 is shaped by pressing portions other than the thick plateportions 5 b and 5 c of the band-shaped thin plate member with athickness of 0.4 mm to 0.2 mm. Thereafter, portions which are away fromboth ends by predetermined length are bent back toward the center toform the base portion 5A and the pair of bent pieces 5B and 5C.Alternatively, as shown in FIG. 6, a thick plate portion 20 c and anengaging protrusion portion 20 d, a thickness of which being 0.4 mm, maybe secured to both ends of a band-shaped thin plate member with athickness of 0.2 mm by means of caulking or welding W to form a stopper20.

The puncture needle 7 is further provided with a tube-shaped proximalmember 7B in which the needle portion 7A is connected to the distal endthereof. The proximal member 7B is formed of a flexible soft member. Theproximal member 7B is formed of an extrusion-molded tube of PEEK (PolyEther Ether Ketone) so as to endure, for example, an expanding andcontracting load, which is to be described later, accompanied with theprotruding and retracting of the puncture needle 7 relative to the outersheath 8 and an expanding load due to the movement of the stopper 5 overthe suture thread 3 accompanied with a tightening of biological tissue.

As shown in FIGS. 7 to 9, the puncture needle 7 is inserted into achannel CH1 of an endoscope insertion portion EI which is to bedescribed later along with the outer sheath 8. The opening 7 a at thedistal end of the puncture needle 7 is inclined relative to thelongitudinal direction of the puncture needle 7. An introduction hole 7b for introducing a loop 18 of the suture thread 3 into a cavity fromthe outside of the puncture needle 7 is formed on the proximal side thanthe distal end position of the pusher 10 on a side surface inside of thepuncture needle 7. Specifically, the introduction hole is disposed at aposition apart from the opening 7 a by more than the total length of thefirst anchor 2A and the second anchor 2B arranged in series. A slit 7 chaving a sufficient width to let the suture thread 3 pass therethroughis disposed from the opening 7 a toward the introduction hole 7 b.

A restriction member 21 for restricting the movement amount of thepusher 10 toward the proximal side in the puncture needle 7 is disposedat a position closer to the proximal side than the introduction hole 7 bof the puncture needle 7 so as to protrude inwardly in the diameterdirection.

The restriction member 21 is disposed in the proximal end of the needleportion 7A which is closer to the proximal side than the introductionhole 7 b of the puncture needle 7 so as to protrude inwardly in thediameter direction. The restriction member 21 is formed such that theslope close to the distal end of the puncture needle 7 is steep and theslope close to the proximal side is gentle. A male screw portion isformed on the outer circumferential surface of the restriction member 21and a female screw portion capable of engaging with the male screwportion is formed at the distal end of the proximal member 7B.Accordingly, by being engaged in a screwing manner, the needle portion7A and the proximal member 7B are coupled to each other with sufficientstrength to endure a high expanding and contracting load with a simplestructure.

The inner circumferential surface of the distal end side of the punctureneedle 7 is provided with protrusions 22 which are to be engaged withthe grooves 2 a when the first anchor 2A and the second anchor 2B arehoused thereinside.

The pusher 10 is made of an elongated wire. The pusher 10 is providedwith an engaging portion 23 which is to be detachably engaged with thesuture thread 3 which is drawn out of the slit 7 c with the anchors 2 ofthe suture tool 6 being housed in the puncture needle 7. The engagingportion 23 is formed by curving a part of the distal end side of thepusher 10.

The outer sheath 8 includes a distal end side sheath 8A which covers thedistal end side of the puncture needle 7, which houses the suture tool6, and a proximal sheath 8B which is connected to the proximal end ofthe distal end side sheath 8A to cover the proximal side. The outersheath 8 is formed of densely winded metal wires 8 a in a coil shape.The distal end side sheath 8A has an inner diameter larger than that ofthe proximal sheath 8B so as to house the stopper 5 and the punctureneedle 7.

The outer surface of the proximal sheath 8B is covered with a resin tube24. The resin tube 24 is closely fixed onto the metal wire 8 a by meansof a thermal contraction. Or the resin tube 24 is formed by means of anextrusion molding by using a coil as a core which is not shown. A resincoating may be used instead of the resin tube 24.

As shown in FIGS. 1, 10, and 11, a U-shaped groove 11 a relative to thedirection of the center axis C1 is formed in the operating portion body11 and a finger laying portion 11 A is disposed in the proximal endthereof. An adjustment stopper 25 for restricting the movement of theneedle slider 12 is disposed in the distal end side of the operatingportion body 11. The adjustment stopper 25 is positioned on theoperating portion body 11 by using a fixing screw 26. The adjustmentstopper 25 is provided with a semi-circular finger laying portion 25A.

The needle slider 12 has a protruding member 12A, which is to be engagedwith the U-shaped groove 11 a, and engages with the operating portionbody 11 so as to advance and retreat. At the proximal end of the needleslider 12, a branch section 27 extending in the direction of a centeraxis C2 which is inclined relative to the center axis Cl is connected tothe protruding member 12A. The needle slider 12 includes two fingerlaying portions 12B.

A pusher through-hole 27 a, through which the proximal end side of thepusher 10 is passed, is provided on the proximal end side of the branchportion 27. A distal end of the pusher through-hole 27 a is inserted bythe proximal end of the proximal member 7B of the puncture needle 7 andis provided with a needle fixing portion 27A which is to be screwedsimilarly to the aforementioned connection of the distal end of theproximal member 7B. The branch portion 27 is formed in a cylinder shapeand is inserted by a movable stopper 16 so as to advance and retreat.

The pusher operating portion 13 is formed into a cylinder shape and isconnected to the proximal end of the pusher 10.

The spring member 15 has a resilient force adjusted so that the movingdistance of the pusher 10 corresponds to the length of one anchor 2 whenit is compressed to the maximum. The resilient force is adjusted to besmaller than the frictional force between the pusher 10 and the punctureneedle 7.

The movable stopper 16 is formed into a bottomed cylindrical shell shapeand is inserted to be slidable in which a bottom portion 16 a isseparated by a predetermined distance from the proximal end 27 b of thebranch section 27. A second end 15 b of the spring member 15 isconnected to the bottom portion 16 a.

The lock member 17 protrudes from the movable stopper 16 in thelongitudinal direction of the pusher operating portion 13 and isresiliently deformed in a direction in which the diameter of the movablestopper 16 decreases.

The suture instrument 1 is used along with an endoscope E, as shown inFIG. 12. The endoscope E includes an endoscope operating portion ESoperated by an operator and a flexible endoscope insertion portion EIextending from the endoscope operating portion ES. The endoscopeinsertion portion EI has channels CH1 and CH2, into which the sutureinstrument I and the like are inserted, which are open at the distal endof the endoscope insertion portion EI. A lighting optical system EL isdisposed at the distal end of the endoscope insertion portion EI.

Next, operations of the suture instrument 1 and the suture tool 6 aredescribed along with a suturing method with reference to FIGS. 13 to 43.The stomach is shown as an example of a hollow organ.

First, in the stopper 5 shown in FIG. 13, as shown in FIG. 14, thesuture thread is inserted into the through-hole 5 a of the base portionSA and the suture thread 3 is inserted while the pair of bent pieces 5Band 5C is deformed in a direction in which the thick plate portions 5 band 5 c are separated from each other. At this time, when the suturethread 3 is drawn in a direction d1 of the base portion 5A, the thickplate portions 5 b and 5 c also move in the direction dl and thedistance between the thick plate portions 5 b and 5 c decreases totightly fasten and lock the suture thread 3, thereby restricting themovement of the suture thread 3.

That is, when a force acts on the suture thread 3 in a direction inwhich the anchors 2 are separated from the stopper 5, the pair of bentpieces 5B and 5C are moved to be closer to each other, thereby lockingthe movement of the suture thread 3. That is, even when an anastomosisobject to be anastomosed by the stopper 5 and the anchors 2 pushes thestopper 5 in a direction d2 toward the other end of the suture thread 3,the thick plate portions 5 B and 5 c tightly fasten the suture thread 3and locks the position of the stopper 5 relative to the suture thread 3.As a result, the stopper 5 is not moved in the direction d2.

On the other hand, as shown in FIG. 15, when the stopper 5 is moved tobe closer to the anchors 2, that is, when the suture thread 3 is drawnin the direction d2 opposite to the base portion 5A, the thick plateportions 5 b and 5 c also move in the direction d2 (in a direction inwhich they are separated from each other), thereby releasing thefastening to the suture thread 3. That is, the movement of the suturethread 3 in the direction in which the anchors 2 and the stopper 5becomes closer to each other is allowed. That is, when the stopper 5 ispressed to the anastomosis object, that is, when the stopper 5 is movedin the direction dl of one end of the suture thread 3, the thick plateportions 5 b and 5 c are opened and the fastening of the thick plateportions 5 b and 5 c to the suture thread 3 is released.

As shown in FIG. 16, the stopper 5 is compulsorily moved in thedirection d2 by the pressure from the anastomosis object. At this time,the base portion 5A of the stopper and the pair of bent portions 5B and5C become substantially parallel to each other. Since this state issimilar to the molded state, the bending stress hardly occurs in thepair of bent pieces 5B and 5C. Accordingly, the fastening force on thesuture thread 3 is maintained without moving relative to the anastomosisobject.

Next, as shown in FIG. 17, the endoscope insertion portion EI isinserted into a mouth of a patient PT wearing a mouthpiece MP and thedistal end of the endoscope insertion portion EI is curved. As shown inFIG. 18, an incising treatment instrument SW such as a snare is insertedinto the channel CH1 of the endoscope insertion portion EI to cut off amucous membrane M3 including a pathological lesion.

On the other hand, as shown in FIG. 19, the first anchor 2A and thesecond anchor 2B of the suture tool 6 are housed in series in thepuncture needle 7 and the protrusion 22 is engaged with the groove 2 aof the first anchor 2A. The suture thread 3 is protruded from the slit 7c and the loop 18 is introduced again into the puncture needle 7 fromthe introduction hole 7 b. The loop 18 is inserted through the pusher 10to engage with the engaging portion 23, thereby maintaining the stopper5 housed in the puncture needle 7.

After cutting off the mucous membrane M3, the suture instrument 1 isinserted into the channel CH1 instead of the incising treatmentinstrument SW and the distal end of the outer sheath 8 is protruded fromthe distal end of the channel CH1.

In this state, as shown in FIG. 20, the needle slider 12 is advancedrelative to the operating portion body 11 and as shown in FIG. 21, thepuncture needle 7 is protruded from the outer sheath 8. At this time,the needle slider 12 is moved forward by means of passing one's thumbthrough the finger laying portion 11A, passing one's index finger, amiddle finger, or a ring finger through the finger laying portion 12B,and opening both fingers. Alternatively, the needle slider 12 may bemoved forward by means of laying one's thumb on the finger layingportion 12B, laying one's index finger, a middle finger, or a ringfinger on the semi-circular finger laying portion 25A, and closing bothfingers. Since this closing operation can permit a finer adjustment thanthe opening operation and thus can apply a force more conveniently, theprotruding amount and the speed of the puncture needle 7 from the outersheath can be more easily controlled.

Next, as shown in FIG. 22, a pair of forceps F is inserted into thechannel CH2 and is protruded from the distal end thereof, grasps adistal cut end M5 of a mucous-membrane defect portion M4 and pulls andholds up the distal cut end in a direction apart from themucous-membrane defect portion M4 as shown in FIG. 23.

In this state, as shown in FIG. 24, the endoscope insertion section EIis curved to define the puncture direction of the puncture needle 7. Atthis time, since the proximal member 7B of the puncture needle 7 isformed of a soft tube the outer portion, in which the pusher 10 as anaxis, expands in the curved direction. On the other hand, since thepusher 10 is a wire having a high rigidity and a small diameter, thepusher 10 does not expand with the curving operation. Accordingly, theengaging portion 23 of the pusher 10 engages with the restriction member21 in the puncture needle 7 and thus the pusher operating portion 13 isrelatively drawn toward the branch portion 27 along with the movablestopper 16.

Thereafter, the needle slider 12 is advanced relative to the operatingportion body 11 until coming in contact with the adjustment stopper 25so as to protrude the puncture needle 7 from the distal end of the outersheath 8. In this way, as shown in FIG. 25, by advancing the entiresuture instrument 1 or the endoscope insertion portion EI, the punctureneedle 7 penetrates the mucous membrane M5 which is supported by meansof operations of the pair of forceps F and the endoscope.

Next, as shown in FIG. 26, the movable stopper 16 and the branch section27 are fixed to each other by grasping the lock member 17 of the movablestopper 16 along with the branch section 27. As shown in FIG. 27, thespring member 15 is compressed by moving the pusher operating portion 13toward the distal end side. At this time, the pusher 10 moves relativeto the puncture needle 7 by the length of one anchor. Accordingly, theprotrusion 22 and the groove 2 a of the first anchor 2A are disengagedfrom each other and thus the second anchor 2B advances, as shown in FIG.28, thereby extruding the first anchor 2A, which is in face contact,toward the front end of the puncture needle 7. Then, the groove 2 a ofthe second anchor 2B newly engages with the protrusion 22. As a result,the first anchor 2A drops to the rear side of the mucous membrane M5.When the puncture needle 7 is pulled out of the mucous membrane M5, thesuture thread 3 penetrates the mucous membrane M5 and the first anchor2A is detained in the distal side of the mucous-membrane defect portionM4.

Subsequently, the lock member 17 is released and thus the movablestopper 16 is restored to the original shape. Here, the resilientrestoring force of the spring member 15 is set smaller than thefrictional force generated over the entire length between the pusher 10and the puncture needle 7. Accordingly, while the spring member 15 isrestored to the original length without a relative movement between thepusher 10 and the puncture needle 7, the movable stopper 16 advancesrelative to the branch portion 27, as shown in FIG. 29.

Next, the front end of the endoscope insertion portion EI is moved tothe place where the second anchor 2B is detained. Similarly to the firstanchor 7A, as shown in FIG. 30, the end portion of a mucous membrane M6in the proximal side which is almost symmetric with the mucous membraneM5 with the mucous-membrane defect portion M4 interposed therebetween isgrasped and supported by the forceps F. By advancing the entire sutureinstrument 1 or the endoscope insertion portion EI with the punctureneedle 7 protruding from the distal end of the outer sheath 8, thepuncture needle 7 penetrates the supported mucous membrane M6.

Here, as shown in FIG. 31, the lock member 17 is grasped again anddeformed to come in contact with the branch portion 27. And as shown inFIG. 32, the pusher operating portion 13 is moved relative to themovable stopper 16 to compress the spring member 15. Accordingly, asshown in FIG. 33, the protrusion 22 and the groove 2 a of the secondanchor 2B are disengaged from each other and thus the second anchor 2Bis discharged to the rear side of the mucous membrane M6. When thepuncture needle 7 is pulled out of the mucous membrane M6, the suturethread 3 penetrates the mucous membrane M6 and the second anchor 2B isdetained in the proximal side of the mucous-membrane defect portion M4,as shown in FIG. 34.

Next, as shown in FIG. 35, the needle slider 12 is retreated toward theproximal side relative to the operating portion body 11. Accordingly,the puncture needle 7 is relatively drawn into the outer sheath 8 andthe distal end of the outer sheath 8 comes in contact with the stopper 5of the suture tool 6, as shown in FIG. 36. Further as shown in FIG. 37,by moving the needle slider 12 to the proximal side, the distancebetween the stopper 5 and the anchors 2 is reduced. The reduction indistance between the anchors 2A and 2B allows the mucous membranes M5and M6 anchored by the anchors 2A and 2B to be drawn closer to eachother. Finally, as shown in FIG. 38, the stopper 5 comes in contact withthe mucous membranes M5 and M6 and is tightly fastened, thereby reducingthe mucous-membrane defect portion M4.

As shown in FIG. 39, the movable stopper 16 is retreated toward theproximal side relative to the branch portion 27. At this time, as shownin FIGS. 40 and 41, the loop 18 of the suture thread 3 gets off from theengaging portion 23 of the pusher 10 and the engaging portion 23 isresiliently deformed so as to go over the restriction member 21, therebymoving the pusher 10 to the proximal side relative to the punctureneedle 7. Here, when the suture instrument 1 or the endoscope insertionsection EI is retreated from the mucous-membrane defect portion M4, theloop 18 is drawn from the introduction hole 7 b of the puncture needle 7to the outside of the puncture needle 7, as shown in FIG. 42. In thisway, as shown in FIG. 43, the suture tool 6 is separated from the sutureinstrument 1, in which the suture thread 3 is maintained not to beloosened by the stopper 5, thereby detaining the suture tool 6.

According to the suture instrument 1, even when the sheath 9 is curved,it is possible to move the pusher operating section 13 relative to theoperating section body 11 along with the expansion and contraction ofthe sheath 9 by setting the movable stopper 16 to the movable state andsetting the spring member 15 to the expanded state. By setting themovable stopper 16 to the fixed state and setting the spring member 15to the contracted state by using the lock member 17, it is possible tomove the position of the distal end 10 a of the pusher 10 relative tothe sheath 9 by a predetermined distance. Accordingly, regardless ofbefore or after the curvedness of the sheath 9, it is possible toprecisely advance and retreat the pusher 10 relative to the sheath 9 bya predetermined distance with a simple operation.

At this time, by grasping the lock member 17 to come in contact with thebranch portion 27, it is possible to fix the movable stopper 16 relativeto the operating portion body 11. On the other hand, when the lockmember 17 is not deformed, the movable stopper 16 can be set to themovable state relative to the branch portion 27.

Since the movable stopper 16 and the branch portion 27 are connected toeach other with the spring member 15, the expanding and contractingamount of the spring member 15 can be easily defined, thereby allowingthe pusher 10 to advance and retreat with high precision.

The engaging portion 23 is disposed in the pusher 10. Accordingly, evenafter the puncture needle 7 punctures the biological tissue and theanchors 2 are detained by moving the pusher 10, the suture thread 3 canbe engage with the pusher. Therefore, by drawing the puncture needle 7into the proximal side of the outer sheath 8 along with the pusher 10 inwhich the outer sheath 8 is in contact with the stopper 5 of the suturetool 6, it is possible to move the stopper 5 toward the anchors 2 side.Thereafter, by disengaging the suture thread 3 from the pusher 10, it ispossible to detain the suture tool 6 in the biological tissue.Accordingly, it is possible to continuously perform the detention andthe suture of the suture tool 6, without replacing a plurality oftreatment tools.

At this time, by introducing the loop 18 of the suture thread 3 into thepuncture needle 7 through the introduction hole 7 b of the punctureneedle 7 and inserting the pusher 10 into the loop 18, it is possible toeasily engage the loop 18 with the engaging portion 23.

By advancing or retreating the needle slider 12 relative to theoperating portion body 11, it is possible to protrude or retreat thepuncture needle 7 relative to the outer sheath 8. By advancing orretreating the pusher operating section 13 relative to the needle slider12, it is possible to advance or retreat the pusher 10 relative to thepuncture needle 7. Here, since the branch section 27 is inclinedrelative to the operating portion body 11, it is possible tocontinuously operate the needle slider 12 and the pusher operatingportion 13 without changing to hold from one portion to another at thetime of operating both portions to advance and retreat.

The outer sheath 8 has a coil shape. As a result, even when the punctureneedle 7 is retracted into the outer sheath 8, with the suture thread 3engaged with the engaging portion 23 and the stopper 5 of the suturethread 3 being pressed by the distal end of the outer sheath 8, it canendure well the compressing force generated in the axis direction of theouter sheath 8.

The proximal sheath 8B is covered by the resin tube 24. As a result,when the puncture needle 7 is extruded from the outer sheath 8, it canendure well the tensile force generated in the outer sheath 8.

As shown in FIG. 41, the restriction member 21 is disposed in thepuncture needle 7. As a result, when the pusher 10 is inserted into thepuncture needle 7 at the time of assembly, the pusher 10 can be insertedinto while coming in contact with the gentle slope portion on theproximal side of the restriction member, thereby making assembly workeasy. On the other hand, when the pusher 10 is carelessly moved towardthe proximal end side of the puncture needle 7 after the assembly, theengaging portion 23 comes in contact with the steep slope portion of therestriction member 21, thereby restricting further movement of thepusher.

According to the suture tool 6, when the suture thread 3 is sandwichedby the thick plate portions 5 b and 5 c of the distal end of the pair ofbent pieces 5B and 5C of the suture tool 6, the contact area between thepair of bent pieces 5B and 5C and the suture thread 3 can be increasedmore suitably, thereby reducing the stress generated in the pair of bentpieces 5B and 5C. Accordingly, the stopper 5 can keep a stable fixingforce to the biological tissue.

When the suture thread 3 is inserted through the stopper 5, the pair ofbent pieces 5B and 5C become inclined relative to the base portion 5A.However, when the stopper 5 is moved relative to the suture thread 3 andis fixed to the biological tissue, the pair of bent pieces 5B and 5C andthe base portion 5A become substantially parallel to each other againsimilarly to the initially processed state. That is, since the pair ofbent pieces 5B and 5C is returned to the initially processed state, theforce for fixing the suture thread 3 is not loosened while the stopper 5is moved. As a result, it is possible to satisfactorily suppressmovement of the bent pieces 5B and 5C relative to the suture thread 3while it is detained.

Since the thick plate portions 5 b and 5 c and the engaging protrusions5 d and 5 e are engaged with each other when sandwiching the suturethread 3 by the use of the stopper 5, it is possible to satisfactorilyprevent the misalignment between the bent pieces 5B and 5C due to aforce having a direction intersecting the center axis C of the pair ofbent pieces 5B and 5C.

As shown in FIGS. 44 to 47, the portion of the puncture needle 28 inwhich the introduction hole 28 b is formed may be decentered to form aprotruding portion 28A. This uses the space S formed between thepuncture needle 28 and the outer sheath 8 because the center axis C3 ofthe outer sheath 8 and the center axis C4 of the puncture needle 28 areoffset when the puncture needle 28 is disposed in the outer sheath 8.

As shown in FIG. 48, an engaging portion 31 of a suture instrument 30may be disposed in a slit shape on the side surface of a puncture needle32.

The suture instrument 30 houses the first anchor 2A and the secondanchor 2B of the suture tool 6 in series in the puncture needle 32,protrudes the suture thread 3 from a slit 32 c, and engages the loop 18with the engaging portion 31, whereby the stopper 5 is housed in thepuncture needle 32.

By means of the same operation as the first embodiment, an anchor (notshown) of the suture tool 6 is detained. When the suture thread 3 isdetached from the engaging portion 31, the puncture needle 32 isprotruded from the outer sheath 8 once and then the puncture needle 32is shaken. At this time, the suture thread 3 is disengaged from theengaging portion 31, as shown in FIG. 49.

According to the suture instrument 30, since the engaging portion 31 hasa slit shape, it is possible to easily engage the loop 18 with thesurface of the puncture needle 32 by hooking a part of the suture thread3 thereto.

As shown in FIG. 50, a suture instrument 33 may include a cover 35covering the engaging portion 31. The cover 35 engages with a guidegroove 37 formed in the surface of a puncture needle 36 and is connectedto a tow member 38 so as to move along the guide groove 37.

According to the suture instrument 33, it is possible to satisfactorilyprevent the suture thread 3 from erroneously departing from the engagingportion 31, by covering the engaging portion with the cover 35 afterengaging the loop 18 with the engaging portion 31. By towing the towingmember 38 to move the cover 35, it is possible to easily disengage theloop 18 from the engaging portion 31.

As shown in FIG. 51, an engaging portion 41 of a suture instrument 40may be disposed to protrude from the side surface of a puncture needle42.

The suture instrument 40 engages the loop 18 with the engaging portion41 and detains an anchor which is not shown. When the suture thread 3 isdisengaged from the engaging portion 41, the suture thread 3 isdisengaged from the engaging portion 41 by protruding the punctureneedle 42 once from the outer sheath 8 and shaking the puncture needle42.

According to the suture instrument 40, since the engaging portion 41 isdisposed to protrude, it is possible to easily engage the loop 18 of thesuture thread 3 with the surface of the puncture needle 42.

As shown in FIG. 52, the pusher 10 may be provided with a cutting edge46 which can cut the suture thread 3 of a suture instrument 45.

Here, the cutting edge 46 is disposed closer to the distal end side ofthe pusher 10 than the engaging portion 23 by a shorter distance thanthe distance between the introduction hole 7 b and the restrictionmember 21. A cutting edge face 46 a is disposed only toward the proximalside.

In the suture instrument 45, by means of the same operation as the firstembodiment, the first anchor 2A and the second anchor 2B of the suturetool 6 are housed in series in the puncture needle 7, the suture thread3 is protruded form the slit 7 c, and the loop 18 is introduced into thepuncture needle 7 through the introduction hole 7 b and is inserted intothe distal end of the stopper 5, thereby engage the loop 18 with theengaging portion 23. Here, since the cutting edge face 46 a is disposedtoward the proximal side, the loop 18 is not cut by the cutting edge 46while the loop 18 is engaged with the engaging portion.

When the suture thread 3 is disengaged from the engaging portion 23, thepusher 10 is drawn into the proximal side relative to the punctureneedle 7. At this time, since the loop 18 comes in contact with thecutting edge face 46 a, the loop 18 is cut and the suture thread 3 isdisengaged from the engaging portion 23.

According to the suture instrument 45, by relatively moving the pusher10 in a direction different from the direction in which the loop 18 ofthe suture thread 3 is inserted, it is possible to easily cut the loop18 with the cutting edge 46 and to disengage the engagement.

As shown in FIG. 53, when a suture tool 47 has only one anchor 48, afirst end 3 a and a second end 3 b of the suture thread 3 may beconnected to the same position of the anchor 48.

As shown in FIG. 54, a suture tool 51 in which the first end 3 a of thesuture thread 3 is connected to the anchor 48 and a ring 50 instead ofthe loop 18 is disposed at the second end 3 b may be used.

As shown in FIG. 55, a suture tool 53 in which a second end of a suturethread 52 is shaped in advance in a loop 18 may be used. As shown inFIG. 56, a suture tool 56 in which the loop 18 is formed by bending backthe suture thread 3 and tying the second end 3 b to an intermediateportion of the suture thread 3 to form a knot 55 may be used.Alternatively, as shown in FIG. 57, a suture tool 11 in which the loop18 is formed by caulking the suture thread with a caulking member 60 maybe used.

Second Embodiment

Next, a second embodiment of the invention will be described withreference to FIGS. 58 to 63.

The same elements as the first embodiment are denoted by the samereference numerals and description thereof is omitted.

The second embodiment is different from the first embodiment, in thatthe endoscopic treatment instrument is a pair of Biopsy test forceps 60instead of the suture instrument 1.

As shown in FIGS. 58 to 59, the Biopsy forceps 60 include a flexiblesheath 61, an operating wire (wire) 62 which is disposed in the sheath61 to advance and retreat, a forceps portion 63 connected to distal endsof the sheath 61 and the operating wire 62, a restriction member 65which restricts the movement of the operating wire 62 in the sheath 61toward the proximal side, an operating portion 66 connected to theproximal end of the sheath 61, a spring member 67 similar to that of thefirst embodiment, a slider portion (wire operating portion) 68 connectedto the proximal end of the operating wire 62 to advance and retreatrelative to the operating portion 66 and connected to a first end 67 aof the spring member 67, a movable stopper 70 connected to a second end67 b of the spring member 67 to be movable relative to the operatingsection 66, and a lock member 71 disposed in the movable stopper 70.

The sheath 61 is constructed by densely winding a metal wire 61 a in acoil shape.

The restriction member 65 includes a first restriction member 65A whichis formed in a cylindrical shape with substantially the same innerdiameter as the inner diameter of the sheath 61 and is disposed at adistal end of the sheath 61 and a second restriction member 65B which isdisposed at a distal end of the operating wire 62 and which is formed toprotrude outwardly in the diameter direction more than the innerdiameter of the sheath 61 and which is formed to be able to come incontact with the first restriction member 65A.

The resilient force of the spring member 67 is controlled to be smallerthan the frictional force between the operating wire 62 and the sheath61.

The forceps portion 63 includes a front cover 72 disposed at the distalend of the sheath 61, a pair of forceps pieces 73A and 73B, and a linkportion 75 which is connected to the distal end of the secondrestriction member 65B and which converts an advancing and retreatingoperation of the operating wire 62 into an opening and closing operationof the pair of forceps pieces 73A and 73B.

The operating portion 66 extends from the proximal end of the sheath 61and a finger laying portion 66A is disposed at the proximal end thereof.The operating portion 66 is provided with a slit 66B which extends inthe longitudinal direction and which is wide enough so that theoperating wire 62 is inserted therethrough.

The slider portion 68 is disposed to be slidable in the longitudinaldirection in a state where it engages with the slit 66B of the operatingportion 66.

The movable stopper 70 includes a connection portion 70A connected tothe operating wire 62 and the lock member 71 is connected to theproximal end side of the connection portion 70A.

The lock member 71 includes a contact portion 71A pressed onto the outercircumferential surface of the operating section 66 and a connectionportion 71B which extends into the slit 66B of the operating portion 66,into which the operating wire 62 is inserted to advance and retreat, andwhich is connected to the second end 67 b of the spring member 67. Thecontact portion 71A has a size which can be pressed by a finger.

Next, an operation of the Biopsy forceps 60 according to this embodimentwill be described with reference to FIGS. 60 to 63. The Biopsy forceps60 are inserted into an endoscope insertion section of an endoscope (notshown) inserted into a living body.

Depending on the use states, the sheath 61 can be changed to the curvedstate as shown in FIG. 60 from the straightly expanded state as shown inFIGS. 58 and 59, in order to define the biological test direction.

At this time, since the proximal side portion of the sheath 61 is soft,the sheath 61 is expanded in a curved direction. On the other hand, theoperating wire 62 does not expand and contract. Accordingly, the secondrestriction member 65B disposed in the operating wire 62 is locked tothe first restriction member 65A disposed in the sheath 61 and thus theslider portion 68 is drawn into the distal end side of the operatingportion 66 along with the movable stopper 70.

Next, as shown in FIG. 61, the lock member 71 of the movable stopper 70is grasped to bring the contact portion 71 A into contact with theoperating portion 66. As shown in FIG. 62, the slider portion 68 ismoved relative to the operating portion 66 to compress the spring member67. At this time, the operating wire 62 is moved by a predeterminedlength relative to the sheath 61 and thus the pair of forceps pieces 73Aand 73B is opened by half.

Subsequently, the lock member 71 is released and restored to theoriginal state. Here, the resilient force of the spring member 67 issmaller than the frictional force between the operating wire 62 and thesheath 61. Accordingly, while the spring member 67 is restored to theoriginal state without the relative movement between the operating wire62 and the sheath 61, the movable stopper 70 advances relative to theoperating portion 66.

Here, when the pair of forceps pieces 73A and 73B is closed, the sliderportion 68 is moved toward the proximal side relative to the operatingportion 66. On the other hand, as shown in FIG. 63, when the pair offorceps pieces 73A and 73B is further opened to the maximum position,the slider portion 68 is further advanced relative to the operatingportion 66.

According to the Biopsy forceps 60, even when the movable stopper 70 isset to the movable state and the spring member is set to the expandingstate so as to curve the sheath 61, it is possible to prevent the pairof forceps pieces 73A and 73B from being opened or closed, by moving theoperating wire operating portion 66 relative to the operating portion 66in accordance with the expansion and contraction of the sheath 61. Inaddition, by moving the operating wire 62 relative to the sheath 61 by apredetermined distance in a state where the movable stopper 70 is set tothe fixed state and the spring member 67 is set to the contracted stateby the use of the lock member 71, it is possible to open or close thepair of forceps pieces 73A and 73B by a predetermined amount.

Although exemplary embodiments of the invention have been describedhitherto, the invention is not limited to the exemplary embodiments. Theelements of the invention may be added, omitted, or replaced withoutdeparting from the gist of the invention. The invention is notrestricted by only the above description, but by only the scope of theappended claims.

1. An endoscopic treatment instrument comprising: a flexible sheath; awire disposed inside the sheath so as to advance and retreat; arestriction member which restricts movement of the wire in the sheath toa proximal side; an operating portion connected to a proximal end of thesheath; a wire operating portion which is connected to a proximal end ofthe wire and disposed to advance and retreat relative to the operatingportion; a resilient member which has a first end and a second end andof which the first end is connected to the wire operating portion toexpand and contract between the second end; a movable member which isconnected to the second end so as to be movable relative to theoperating portion; and a control member which is disposed in the movablemember and which switches the movable member between a movable state anda fixed state relative to the operating portion.
 2. The endoscopictreatment instrument according to claim 1, wherein the movable member isslidable relative to the operating portion, and wherein the controlmember protrudes from the movable member and is resiliently deformed ina direction of reducing a diameter of the movable member.
 3. Theendoscopic treatment instrument according to claim 2, wherein the sheathfurther comprising: a hollow puncture needle which houses the wirehaving a hard needle portion disposed at the distal end thereof so as toadvance and retreat, and an outer sheath which houses the punctureneedle so as to advance and retreat, wherein the operating portionfurther comprising: an operating portion body which is connected to andextends from a proximal end of the outer sheath, and a slider portionwhich is connected to a proximal end of the puncture needle so as toadvance and retreat relative to the operating portion body, wherein themovable member is slidably disposed in the slider portion.
 4. Theendoscopic treatment instrument according to claim 2, further comprisinga forceps portion connected to distal ends of the sheath and the wire.5. The endoscopic treatment instrument according to claim 1, wherein theresilient member is a spring member.